Lundbeck presented new data at the American Academy of Neurology (AAN) 2025 meeting demonstrating the sustained efficacy of Vyepti (eptinezumab) for migraine prevention, with a particular focus on meaningful patient-reported outcomes.
The data highlighted significant improvements in patient quality of life, with a notable reduction in brain fog symptoms. Patients who experienced a 75% or greater increase in "good days" per month showed substantially higher rates of brain fog improvement compared to those with less response—a finding that supports Lundbeck's strategy of "raising the bar around preventive treatment expectations in migraine."
Changing Landscape of Migraine Prevention
Migraine prevention has traditionally relied on repurposed medications including beta-blockers, calcium antagonists, antidepressants, and anti-epileptics. However, these oral treatments often come with poor side-effect profiles and limited efficacy, leading many patients to cycle through multiple medication classes without adequate relief.
The introduction of anti-CGRP (calcitonin gene-related peptide) monoclonal antibodies (mAbs) like Vyepti represented the first class of preventive therapies specifically developed for migraine. These were followed by oral gepants, though both classes have typically been restricted to second- or third-line use due to reimbursement policies requiring failure of traditional oral preventives first.
Dr. James Thompson, neurologist and headache specialist at University Medical Center, explains: "The anti-CGRP therapies have transformed our approach to migraine prevention. We're now able to offer treatments that were designed specifically for migraine biology rather than medications repurposed from other conditions."
New Treatment Guidelines and Market Implications
In a significant development for migraine care, the American Headache Society published a 2024 statement recommending anti-CGRP mAbs and gepants as first-line preventive options. This recommendation acknowledges their superior efficacy and tolerability compared to traditional oral preventives.
The long-term sustained efficacy data presented for Vyepti at AAN 2025 strengthens the case for first-line adoption of these therapies. However, implementation of these recommendations by insurance companies remains uncertain due to the significant cost differential between traditional oral preventives and the newer biologics.
"The clinical evidence clearly supports earlier use of anti-CGRP therapies," notes Maria Chen, PharmD, a clinical pharmacy specialist in neurology. "The challenge now is aligning reimbursement policies with the clinical evidence to ensure patients can access these more effective treatments without first failing multiple less effective options."
Competitive Landscape and Vyepti's Position
Vyepti faces substantial competition in the anti-CGRP space from three other monoclonal antibodies: Amgen's Aimovig (erenumab), Eli Lilly's Emgality (galcanezumab), and Teva's Ajovy (fremanezumab). Additional competition comes from oral gepants including Pfizer's Nurtec (rimegepant) and AbbVie's Qulipta (atogepant).
Key opinion leaders indicate that the CGRP mAbs have similar efficacy profiles, with treatment selection often driven by side effect profiles, dosing schedules, and patient preferences. As the only intravenously administered mAb in this class, Vyepti may face challenges with patients who prefer self-administered options.
To maintain competitiveness, Lundbeck is emphasizing Vyepti's long-term efficacy data and patient-reported outcomes. The focus on meaningful benefits such as reduction in brain fog and increase in "good days" represents a strategic approach to differentiation in an increasingly crowded market.
Clinical Significance and Patient Impact
The data presented at AAN 2025 underscores the clinical significance of Vyepti's effects beyond simple headache reduction. Patients receiving Vyepti who achieved a 75% or greater increase in good days per month reported substantial improvements in cognitive symptoms like brain fog—a debilitating aspect of migraine that significantly impacts quality of life.
"Brain fog and cognitive impairment are often overlooked aspects of migraine that can be just as disabling as the pain itself," explains Sarah Williams, MD, Director of the Headache Center at Metropolitan Neurological Institute. "Having treatments that address these symptoms represents a major advance in comprehensive migraine management."
For patients with frequent migraines, the sustained efficacy demonstrated by Vyepti offers hope for consistent relief without the "wearing off" effect sometimes seen with other preventive options. The intravenous administration every 12 weeks may also provide advantages for treatment adherence compared to more frequently dosed alternatives.
As the migraine treatment landscape continues to evolve, the data presented at AAN 2025 reinforces the potential of targeted therapies like Vyepti to deliver meaningful improvements in patient outcomes and quality of life. Whether these clinical advances will translate into broader first-line access remains a key question for patients, clinicians, and the healthcare system.
